Colorado State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Colorado Medicaid

Colorado
Medicaid Program: Colorado Medicaid

Program Administrator: Colorado Dept. of Health Care Policy and Financing

Regional Telehealth Resource Center:

Southwest Telehealth Resource Center
PO Box 245105

Tucson, AZ 85724
(520) 626-4498
www.southwesttrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the delivery of medical services and any diagnosis, consultation, or treatment using interactive audio, interactive video, or interactive data communication.”

Source: CO Revised Statutes 12-36-102.5 (2012).

Telehealth means a mode of delivery of healthcare services through telecommunications systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person’s health care while the covered person is located at an originating site and the provider is located at a distant site. The term includes synchronous interactions, store -and-forward transfers and services provided through HIPAA Compliant interactive audio visual communication or the use of a HIPAA compliant application via a cellular telephone. Telehealth does not include the delivery of health care services via voice only telephone communication or text messaging, facsimile machine or electronic mail.

Source: CO Revised Statutes 10-16-123(2) (h) (4) (e) (I & II) (2015).

“Telehealth” means a mode of delivery of health care services through telecommunication systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education and care management of a resident’s health care when the resident and practitioner are located at different sites. Telehealth includes ‘telemedicine’ as defined in Section 12-36-102.5(8), C.R.S.”

Source: 6 CO Regs. Rule 1011-1. Ch. 5.

“Telemedicine” or “telehealth” means, for the purposes of this regulation, a mode of delivery of health care

Telemedicine is not a unique service, but a means of providing selected services approved by Health First Colorado through live interactive audio and video telecommunications equipment.

Source: CO Department of Health Care Policy and Financing.

“Telemedicine” 5/17. (Accessed Oct. 2017).

Telehealth services include the installation and on-going remote monitoring of clinical data through technologic equipment in order to detect minute changes in the client’s clinical status that will allow Home Health agencies to intercede before a chronic illness exacerbates requiring emergency intervention or inpatient hospitalization.

Source: CO Medical Assistance Program, Home Health Billing Manual, p. 12 (5/17), (Accessed Oct. 2017).

Telehealth allows for the monitoring of a member’s health status remotely via equipment, which transmits data from the member’s home to the member’s home health agency. The purpose of providing telehealth services is to assist in the effective management and monitoring of members whose medical needs can be appropriately and cost-effectively met at home through the frequent monitoring of data and early intervention.

Source: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Oct. 2017).

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STATE LAW/REGULATIONS MEDICAID PROGRAM

services through telecommunications systems, including

information, electronic and communication technologies,
to facilitate the assessment, diagnosis, consultation,
treatment, education, care management, or self-
management of a covered person’s health care while
the covered person is located at an originating site and
the provider is located at a distant site. The terms
include synchronous interactions and store-and-forward
transfers. The terms do not include the delivery of health
care services via telephone, facsimile machine or
electronic mail systems.

Source: 3 CCR 702-4, 4-2-53.

Worker’s Compensation

Telehealth – a mode of delivery of health care services
through telecommunications systems, including
information, electronic, and communication
technologies, to facilitate the assessment, diagnosis,
consultation, treatment, education, care management,
and/or self-management of an injured worker’s health
care while the injured worker is located at an originating
site and the provider is located at a distant site. The

term includes synchronous interactions and store-and-
forward transfers. The term does not include the delivery
of health care services via telephone with audio only
function, facsimile machine, or electronic mail systems.

Workers Compensation

Telemedicine means two-way, real time interactive
communication between the injured worker, and the
provider at the distant site. This electronic
communication involves, at minimum, audio and video
telecommunications equipment. Telemedicine enables
the remote diagnoses and evaluation of injured workers
in addition to the ability to detect fluctuations in their
medical condition(s) at a remote site in such a way as to
confirm or alter the treatment plan, including
medications and/or specialized therapy.

Source: 7 CCR 1101-3, Rules 16.

Live Video Reimbursement

A health benefit plan that is issued, amended or renewed shall not restrict or deny coverage solely because the service is provided through telehealth.

Source: CO Revised Statutes 10-16-123.

(also see Medicaid column & “Private Payers” section)

CO Medicaid will cover telemedicine direct member services which can involve up to two collaborating providers and the member. It is also acceptable for an originating provider not to be present, as long as the telecommunication equipment facilitates live contact between a member and a distant provider.

A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

A specialist is eligible to be an originating provider or
distant provider.
Managed care may or may not reimburse telemedicine
costs.
Source: CO Department of Health Care Policy and Financing.
“Telemedicine” 5/17. (Accessed Oct. 2017).
Colorado Medicaid will reimburse for medical and
mental health services. Services shall be subject to
reimbursement policies developed by the medical
assistance program.
Reimbursement must be the same as in-person
services.
Source: CO Revised Statutes 25.5-5-320.

Store and Forward Reimbursement

A health benefit plan that is issued, amended or The member must be present during any Telemedicine
renewed shall not restrict or deny coverage solely Direct Member Services that involve two collaborating
because the service is provided through telehealth. providers.
Reimbursement based upon the definition of
“telehealth”. Source: CO Department of Health Care Policy and Financing.
“Telemedicine” 5/17. (Accessed Oct. 2017).
Source: CO Revised Statutes 10-16-123.

Remote Patient Monitoring Reimbursement

(see Medicaid column) The CO Medical Assistance Program will reimburse for
Remote Patient Monitoring at a flat fee set by the state
board when all these requirements are met:
The patient is receiving services from a home
health provider for at least one of the following:
congestive heart failure, chronic obstructive
pulmonary disease, asthma, or diabetes;
The patient requires monitoring at least five
times weekly to manage the disease, as ordered
by a physician or podiatrist;
The patient has been hospitalized two or more
times in the last 12 months for conditions related
to the disease;
The patient or caregiver misses no more than
five monitoring events in a 30-day period;
The patient’s home has space for all program
equipment and full transmission capability.
Source: (Reimbursement): CO Revised Statutes 25.5-5-321.
Source: (Requirements): 10 CO Code of Regulation 2505-10.
Additional restrictions apply. See Colorado Code of
Regulations for more information.
Medicaid Home Health will reimburse for services only if
the patient has no other insurance.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: 10 CO Code of Regulation 2505-10.
CO Medicaid reimburses telehealth monitoring for
qualified clients (see above requirements).
Acute home health agencies and long-term home health
agencies are reimbursed for the initial installation and
education of telehealth monitoring equipment and can
be billed once per client per agency. The agency can
also bill for every day they receive and review the
client’s clinical information.
No prior authorization needed, but agencies should
notify the Department or its designee when a client is
enrolled in the service.
Source: CO Medical Assistance Program, Home Health Billing
Manual, p. 12 (5/17), (Accessed Oct. 2017).

Email/Phone/FAX

A health plan is not required to pay for consultation No reimbursement for telephone.
provided by a provider by telephone or facsimile unless No reimbursement for FAX.
the consultation is provided through HIPAA compliant
interactive audio-visual communication or the use of a Source: CO Department of Health Care Policy and Financing.
HIPAA compliant application via a cellular telephone. “Telemedicine” 5/17. (Accessed Oct. 2017).
Source: CO Revised Statutes 10-16-123.

Online Prescribing

Pharmacists are prohibited from dispensing prescription No reference found.
drugs if they know, or should have known, that it was
on the basis of an internet-based questionnaire,
an Internet-based consult, or a telephone consultation,
all without a valid pre-existing patient-practitioner
relationship.
Source: 3 CO Code of Regulation 719-1 (2012).
Workers’ Compensation
The physician-patient relationship/psychologist-patient
relationship can be established through live audio/video
services.
Source: 7 CO Regs. Rule 18.

Consent

Providers shall give all first-time patients a written The Medicaid requirement for face-to-face contact
statement that includes the following: between provider and member may be waived prior to
treating the member through telemedicine for the first
The patient may refuse telemedicine services at time. The rendering provider must furnish each member
any time, without loss or withdrawal of with all of the following written statements which must be
treatment; signed by the member or the member’s legal
All applicable confidentiality protections shall representative:
apply to the services; The member retains the option to refuse the
The patient shall have access to all medical
delivery of health care services via telemedicine at

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STATE LAW/REGULATIONS MEDICAID PROGRAM

information from the services, under state law. any time without affecting the member’s right to
future care or treatment and without risking the loss
Source: CO Revised Statutes 25.5-5-320 (2012). or withdrawal of any program benefits to which the
Workers’ Compensation member would otherwise be entitled.
All applicable confidentiality protections shall apply

The patient needs to give consent.
to the services.

Source: 7 CO Regs. Rule 18. The member shall have access to all medical
information resulting from the telemedicine services

as provided by applicable law for client access to
his or her medical records.
These requirements do not apply in an emergency.
Source: CO Department of Health Care Policy and Financing.
“Telemedicine” 5/17. (Accessed Oct. 2017).

Location

Workers’ Compensation

Telehealth facilities can bill for the originating site fee unless it’s a private residence.

Authorized originating sites include:

The office of a physician or practitioner

A hospital

A critical access hospital (CAH)

A rural health clinic (RHC)

A federally qualified health center (FQHC)

A hospital based or critical access hospital based renal dialysis center (including satellite)

A skilled nursing facility (SNF) Community Mental Health Center

Source: 7 CO Regs. Rule 18.

If no originating provider is present, then the location of the originating site is at the member’s discretion and can include the member’s home.

Source: CO Department of Health Care Policy and Financing.

“Telemedicine” 5/17. (Accessed Oct. 2017).

Cross-State Licensure

No reference found. No reference found.

Private Payers

A health benefit plan that is issued, amended or No reference found.
renewed shall not restrict or deny coverage solely
because the service is provided through telehealth OR
based on the communication technology or application
used to deliver the telehealth services, subject to the
terms and conditions of the plan.
Source: CO Revised Statutes 10-16-123.

Site/Transmission Fee

A carrier shall include in the payment for telehealth interactions reasonable compensation to the originating site for the transmission cost incurred during the delivery of health care services through telehealth except for when the originating site is a private residence.

Source: CO Revised Statutes 10-16-123.

The originating site is eligible for a facility fee.

Providers eligible for the originating site facility fee include:

Physician

Clinic

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Osteopath

FQHC

Doctorate Psychologist

MA Psychologist

Physician Assistant

Nurse Practitioner

Rural Health Clinic

Other sites can serve as an originating site, but cannot

collect the facility fee.

Using modifier GT adds $5.00 to the procedure code

billed for the service for distant site providers for the

transmission fee. A specific list of eligible codes is
provided in the manual. Other codes can be billed, but
don’t pay the telemedicine transmission fee.

Source: CO Department of Health Care Policy and Financing.

“Telemedicine” 5/17. (Accessed Oct. 2017).

The CO Medical Assistance Program will reimburse for

transmission costs, at a rate set by their state
department.

Source: CO Revised Statutes 25.5-5-320 (2012).

Miscellaneous

Provider of telemedicine services are required to

implement certain confidentiality procedures.

Source: CO Department of Health Care Policy and Financing.
“Telemedicine” 5/17. (Accessed Oct. 2017).

Comments: Colorado law includes in its definition of “health care services” the rendering of services via telemedicine.

CO Revised Statutes 10-16-102 (2012).

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